First-time Traumatic Patellar Dislocation

Abstract

Acute patellar dislocations can result in patellar instability, pain, recurrent dislocations, decreased level of sporting activity, and patellofemoral arthritis. The initial management of a first-time traumatic patellar dislocation is controversial with no evidence-based consensus to guide decision making. Most first-time traumatic patellar dislocations have been traditionally treated nonoperatively; however, there has been a recent trend in initial surgical management. We performed a systematic review of Level I-IV studies to make evidence-based medicine recommendations on how a clinician should approach the diagnosis and treatment of a first-time traumatic dislocation. More specifically we answer the primary question of when initial treatment should consist of operative versus closed management. Based on the review of 70 articles looking at study design, mean followup, subjective and validated outcome measures, redislocation rates, and long-term symptoms, we recommend initial nonoperative management of a first-time traumatic dislocation except in several specific circumstances. These include the presence of an osteochondral fracture, substantial disruption of the medial patellar stabilizers, a laterally subluxated patella with normal alignment of the contralateral knee, or a second dislocation, or in patients not improving with appropriate rehabilitation.

Traumatic Patellar Dislocation and Cartilage Injury: A Follow-up Study of Long-Term Cartilage Deterioration

“…Traumatic lateral patellar dislocation (LPD) is a common injury in young, physically active adults 16,19,23 . It is the second most common cause of hemarthrosis of the knee.…”

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

“…[11][12][13][14][15][16] Patellar dislocation is arguably an exception, as is the grossly unstable knee. 1,[17][18][19][20] Management of these patients is undertaken in different clinical environments by various health care providers. For many acute injuries, the initial presentation for medical care occurs in the emergency department (ED).…”

Patellar dislocation: Not the bees knees

“…29 3% of all knee injuries. Females are more likely to be affected than males (Fithian, 2004) 69 with patellar dislocations being the second most common reason for knee haemarthrosis 70 (Stefancin and Parker, 2007). A number of factors predisposing patients to patellar 71 dislocation have been identified in the literature (see Table 1 …”